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FOR OFFICE E: APPLICATION FOR SANITATION PERMIT ��-i3 �� Permit No- - -----------6 -- (Complete in Triplicate) J______-______-________-_-_ This Permit Expires 1 Year From Date Issued Date Issued.3-//._70 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION TRACT .......... Owner's Name --- .t2PJ71,ZIZ�4�--------/,,-V --------------------------------- ---------- ------------------------Phone��.J1 -��---------- Address --Pic ----->63-ox'-f------ X11 _` ------------------------------------ ------------ City ---------------------------- ---•-- Contractor's Name -------S�;CY16,----------------------License # 3-- Phonew.`-5W2Z------- Installation will serve: Residence ❑Apartment Housef❑ Commercial Trailer Court ;❑ 114 t l��ht�j3 / Motel ❑Other ------------------------------------------ ! Number of living units:___- Number of bedrooms ___ _____Garbage Grinder _________ Lot Size 11242-__ ............. Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ___________________-____ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) M PACKAGE TREATMENT [ ] SEPTIC TANK Size-01 11------------ ------- Liquid Depth __/____________________ Capacity/� 6, __ Type L f____ Material4'AW 0./'-No. Compartments __.•.............. Distance to nearest: Well ----f---_____________________Foundation _AG_)--------------- Prop. Line __s_..__..______--- _ LEACHING LINE ;rj(j No. of Lines ---I------------------- Length of each line____y'�_ ___ ___-__-__ Total Length &_a 'D' Box _N-00— Type Filter Material _AF�O5,-___.Depth Filter Material _ _y•___................................ t i � Distance to nearest: Well __,{-_r____-_-___-__ Foundation _C!J________________ Property Line .,5_____________________ SEEPAGE PIT [ Depth _t9X ________ Diameter -j.-.>--------- Number -------r------------------ Rock Filled Yes Q No i❑ rr�x3------------ Water Table Depth _/_00___________________------------------Rock Size --- Distance to nearest: Well _/__O,0_-'---------------------------Foundation J_G--------•--- Prop. Line _.�- _--_._---- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date -------_-------------------------.) SepticTank (Specify Requirements) --- ----------------------------------------------------------------------------------------------------------,.-------------------•--•----- Disposal Field (Specify Requirements) ------------ - ------------------------------------------------------------------- ;. -------------•---------- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subj t to W r�m�an's Compensation laws of California." - "- Signed ---------- - Own e .r BY ------ -------------- ----------------------------------------- -------------•------------------------ Title ` (If other than owner) le 7 R EPA1TMENT USE ONLY APPLICATION ACCEPTED BY ------- --- -------------------------------- DATE _. :� , 1 ----------------------- BUILDINGPERMIT ISSUED ---- ------- -- -- ---- - - ----- -- --------------------------------------------------- ---DATE -------------•----------------------------- ADDITIONALCOMMENTS ------- --- ----- ------- ---------------- ------------------------------------------------------------=--------•-------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- ------- ----- ------------------ -- - - - -------------- --- --------------------------------------------------------------- ----- - - ----- - --- - Final Inspection b ----------------------------------------------- ------Date✓ �� __-. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M